<div id="mainLeft">
<h1 class="titleH1"><span class="inner">エントリー</span></h1>

<div class="paragraphBox">
<div class="txtListBox">
<form name="campaigngirlForm" id="campaigngirlForm" action="/inquiry/campaigngirl2012send/" method="post">
<p>■氏名</p>
<p class="input">{$Name}<input type="hidden" name="Name" id="Name" value="{$Name}" /></p>
<p>■フリガナ</p>
<p class="input">{$Kana}<input type="hidden" name="Kana" id="Kana" value="{$Kana}" /></p>
<p>■住所</p>
<p class="input">
	〒&nbsp;{$Zip1}&nbsp;-&nbsp;{$Zip2}<input type="hidden" name="Zip1" id="Zip1" value="{$Zip1}" /><input type="hidden" name="Zip2" id="Zip2" value="{$Zip2}" />&nbsp;&nbsp;
	{$PrefStr}<input type="hidden" name="PrefStr" id="PrefStr" value="{$PrefStr}" /><input type="hidden" name="PrefCd" id="PrefCd" value="{$PrefCd}" /><br />
	{$Address}<input type="hidden" name="Address" id="Address" value="{$Address}" />
</p>
<p>■TEL</p>
<p class="input">{$Tel1}&nbsp;-&nbsp;{$Tel2}&nbsp;-&nbsp;{$Tel3}<input type="hidden" name="Tel1" id="Tel1" value="{$Tel1}" /><input type="hidden" name="Tel2" id="Tel2" value="{$Tel2}" /><input type="hidden" name="Tel3" id="Tel3" value="{$Tel3}" /></p>
<p>■携帯</p>
<p class="input">{$Mobile1}&nbsp;-&nbsp;{$Mobile2}&nbsp;-&nbsp;{$Mobile3}<input type="hidden" name="Mobile1" id="Mobile1" value="{$Mobile1}" /><input type="hidden" name="Mobile2" id="Mobile2" value="{$Mobile2}" /><input type="hidden" name="Mobile3" id="Mobile3" value="{$Mobile3}" /></p>
<p>■連絡先TEL</p>
<p class="input">{$Contact1}&nbsp;-&nbsp;{$Contact2}&nbsp;-&nbsp;{$Contact3}<input type="hidden" name="Contact1" id="Contact1" value="{$Contact1}" /><input type="hidden" name="Contact2" id="Contact2" value="{$Contact2}" /><input type="hidden" name="Contact3" id="Contact3" value="{$Contact3}" /></p>
<p>■メール</p>
<p class="input">{$Mail}<input type="hidden" name="Mail" id="Mail" value="{$Mail}" /></p>
<p>■性別</p>
<p class="input">{$SexStr}<input type="hidden" name="SexStr" id="SexStr" value="{$SexStr}" /><input type="hidden" name="Sex" id="Sex" value="{$Sex}" /></p>
<p>■生年月日</p>
<p class="input">
	{$Year}&nbsp;年&nbsp;&nbsp;{$Month}&nbsp;月&nbsp;&nbsp;{$Day}&nbsp;日<input type="hidden" name="Year" id="Year" value="{$Year}" /><input type="hidden" name="Month" id="Month" value="{$Month}" /><input type="hidden" name="Day" id="Day" value="{$Day}" />
</p>
<p>■血液型</p>
<p class="input">{$BloodStr}<input type="hidden" name="BloodStr" id="BloodStr" value="{$BloodStr}" /><input type="hidden" name="Blood" id="Blood" value="{$Blood}" /></p>
<p>■サイズ</p>
<p class="input">
	身長&nbsp;{$Height}&nbsp;cm&nbsp;&nbsp;体重&nbsp;{$Weight}&nbsp;kg<br />
	バスト&nbsp;{$Breast}&nbsp;cm&nbsp;&nbsp;ウエスト&nbsp;{$Waist}&nbsp;cm<br />
	ヒップ&nbsp;{$Hip}&nbsp;cm&nbsp;&nbsp;靴のサイズ&nbsp;{$Foot}&nbsp;cm
	<input type="hidden" name="Height" id="Height" value="{$Height}" />
	<input type="hidden" name="Weight" id="Weight" value="{$Weight}" />
	<input type="hidden" name="Breast" id="Breast" value="{$Breast}" />
	<input type="hidden" name="Waist" id="Waist" value="{$Waist}" />
	<input type="hidden" name="Hip" id="Hip" value="{$Hip}" />
	<input type="hidden" name="Foot" id="Foot" value="{$Foot}" />
</p>
<p>■最終学歴</p>
<p class="input">{$AcademicStr}<input type="hidden" name="Academic" id="Academic" value="{$Academic}" /></p>
<p>■職歴・芸歴</p>
<p class="input">{$CareerStr}<input type="hidden" name="Career" id="Career" value="{$Career}" /><p>
<p>今現在、モデル事務所もしくはイベントコンパニオン事務所等に登録していますか？</p>
<p class="input">
	{$EntryStr}{if $Entry == '1'}&nbsp;&nbsp;事務所名&nbsp;{$Office}{/if}
	<input type="hidden" name="EntryStr" id="EntryStr" value="{$EntryStr}" /><input type="hidden" name="Entry" id="Entry" value="{$Entry}" /><input type="hidden" name="Office" id="Office" value="{$Office}" />
</p>
<p>■趣味・特技</p>
<p class="input">{$HobbySkillStr}<input type="hidden" name="HobbySkill" id="HobbySkill" value="{$HobbySkill}" /></p>
<p>■長所・短所</p>
<p class="input">{$StWkPointStr}<input type="hidden" name="StWkPoint" id="StWkPoint" value="{$StWkPoint}" /></p>
<p>■尊敬する人</p>
<p class="input">{$RespectStr}<input type="hidden" name="Respect" id="Respect" value="{$Respect}" /></p>
<p>■最近、興味がある事</p>
<p class="input">{$InterestStr}<input type="hidden" name="Interest" id="Interest" value="{$Interest}" /></p>
<p>■志望動機</p>
<p class="input">{$ReasonStr}<input type="hidden" name="Reason" id="Reason" value="{$Reason}" /></p>
<p>■自己PR</p>
<p class="input">{$PrStr}<input type="hidden" name="Pr" id="Pr" value="{$Pr}" /></p>
<p>■写真</p>
<p class="input">
	上半身写真&nbsp;{$PhotoName1}<br />全身写真&nbsp;{$PhotoName2}
	<input type="hidden" name="PhotoName1" id="PhotoName1" value="{$PhotoName1}" /><input type="hidden" name="PhotoPath1" id="PhotoPath1" value="{$PhotoPath1}" />
	<input type="hidden" name="PhotoName2" id="PhotoName2" value="{$PhotoName2}" /><input type="hidden" name="PhotoPath2" id="PhotoPath2" value="{$PhotoPath2}" />
</p>
<input type="hidden" name="SiteKbn" id="SiteKbn" value="1" />

<br />

<div class="entryBotton">
<input type="image" name="Reset" id="Reset" src="/sp/images/btn_edit.png" alt="修正する" width="156" height="44" onclick="javascript:BackToEntry(); return false;" />
<input type="image" name="Submit" id="Submit" src="/sp/images/btn_send.png" alt="送信" width="156" height="44" onclick="submit(); return false;" />
</div>
{literal}
<script type="text/javascript">
<!--
function BackToEntry(){
	var fm = document.getElementById("campaigngirlForm");
	fm.action = '/inquiry/campaigngirl2012/sp/';
	fm.submit();
}
//-->
</script>
{/literal}

</form>
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</div><!--/paragraphBox-->


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